Zusammenfassung
Bei Demenzen treten oft depressive Symptome, Angst, Halluzinationen oder Wahn auf und diese sind mit eher unspezifischen Verhaltensänderungen verbunden. Eine zielgerichtete Pharmakotherapie ist durch die Grunderkrankung und die damit verbundenen Komorbiditäten erschwert. Die vorliegende Übersicht beschränkt sich auf die neuere Evidenzlage zu Antidepressiva und Antipsychotika bei psychotischen Störungen, Agitation und Depression bei Demenzen und stützt sich auf die publizierten randomisierten kontrollierten Studien und Metaanalysen. Die Evidenzlage zur Gabe von Antipsychotika in unterschiedlichen Indikationsbereichen favorisiert den Einsatz von Risperidon, mit geringerer Evidenz auch Quetiapin und Aripiprazol, Haloperidol sollte nicht eingesetzt werden. Bezüglich Antidepressiva wird der Nutzen einer Pharmakotherapie depressiver Alzheimer-Patienten wegen des Nebenwirkungspotenzials generell kritisch diskutiert. Dennoch wirken sich selektive Serotoninwiederaufnahmehmmer wie Citalopram und mit geringerer Evidenz auch Sertralin zumindest auf neuropsychiatrische Begleitsymptome günstig aus. Die Schlussfolgerungen folgen den Empfehlungen der derzeitig gültigen DGN/DGPPN S3-Behandlungsleitlinie Demenzen.
Summary
In dementia depressive symptoms, anxiety, hallucinations and delusions often occur and are accompanied by unspecific behavioral changes. A targeted pharmacotherapy is complicated by the underlying cognitive impairment and physical comorbidities. The current review focusses on recent evidence on the use of antidepressives and antipsychotics for psychotic disturbances, agitation and depression in dementia and analyzes currently published randomized controlled clinical trials and meta-analyses. The evidence on the use of antipsychotics for different indications favors risperidone, with lower evidence levels for quetiapine and aripiprazole, whereas haloperidol should be avoided. Increased mortality and the risk of cerebrovascular events due to antipsychotics are of major concern. With respect to antidepressives, the benefit of antidepressive pharmacotherapy in dementia is critically discussed because of limited efficacy and increased side effects; however, selective serotonin reuptake inhibitors (SSRI), such as citalopram and sertraline have demonstrated efficacy on neuropsychiatric behavioral symptoms in general. These conclusions on the risk-benefit ratio of antidepressives and antipsychotics in dementia are in accordance with the recommendations of the German Society of Neurology and German Association for Psychiatry, Psychotherapy and Psychosomatics (DGN/DGPPN) S3 guidelines on the treatment of dementia.
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Interessenkonflikt. L. Frölich und L. Hausner geben an, dass kein Interessenkonflikt besteht.
Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Frölich, L., Hausner, L. Therapie mit Antipsychotika und Antidepressiva bei Demenzen. Nervenarzt 86, 461–467 (2015). https://doi.org/10.1007/s00115-014-4178-4
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DOI: https://doi.org/10.1007/s00115-014-4178-4